Systems
A place where information about processes and steps can be found.
What is Knowledge Central?
"Hello, thank you for calling. My name is Ann, how may I help you?"
What is a good call opening?
Documentation about your calls or disciplinary actions.
An amount of one-way trips to plan approved locations.
What is Transportation?
Calling a provider due to a billing issue.
What is balance billing?
A place where you can find PA decisions and complete HRA's.
What is ICUE?
A team of SME's available to assist with questions or take an escalated call.
What is the NEST team?
Secondary number used to open a facets account with documentation.
What is the Family Link?
Funds set aside for the purchase of medical items such as band aids, Cough syrup, or vitamins.
Submitted on behalf of the member to show medical necessity.
What is a Prior Authorization?
Where you can find Aligned vs Unaligned status and other MCO's.
What is DMEVS?
A note left to the main point of contact for a member.
What is a compassion embrace?
A higher up responsible for assisting in chats, giving assistance with question, and taking escalated calls.
Reviews medical history, current health conditions, diagnosis, medication, and other health questions for 45-60 minuites.
What are House Calls.
Searching for the navigators supervisor
A list of plan benefits that can be accessed by the member.
What is the EOC?
A member not wanting to receive letters.
What is Do not call. mail, or email?
What is Avaya?
Contacts or frames, with standard (single, bi-focal, tri-focal or standard progressive) lenses.
What is the vision benefit?
Member requesting a service to be covered that is not covered by the plan.
What is a MIOD?
Something that only appears if there are A&G cases on file for the member.
What is the A&G tab?
Active listening, Showing Compassion, Acknowledging Emotion, Respect the Caller, Offer Assistance
What are De-Escalation Strategies.
Extra benefits that is used to increase the coverage of your group health insurance
What are ancillary benefits?
Deals with pharmacy benefits such as overrides and emergency overrides.
Who is Optum Pharmacy?
Reporting an issue that could impact health outcomes in a negative manner.
What is a Quality of Care Grievance?